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Individual Regular Membership Application

Once this form is completed it will be sent to the Data Manager for processing, he will in turn send you the link to the Paypal shopping cart to complete your transaction.

NOTE: ALL MEMBERSHIP DATA IS PROTECTED BY THE PRIVACY ACT OF 1974 AND WHERE APPLICABLE THE GENERAL DATA PROTECTION REGULATION. THE ONLY DATA AVAILABLE THROUGH LOOK UP SOURCES IS CONSIDER NON PRIVATE.

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NOTICE TO ALL CURRENT/FUTURE MEMBERS

Effective immediately, we will no longer offer a printed version of the 10-10 International News with new memberships and renewals. It will continue to be published and emailed on the established schedule of mid-January, April, July and October in an electronic version and available on the website to members.

Life and Senior Life members currently receiving the Newsletter by hard copy will be notified and given an option to opt out. If they do not choose this option, the hard copy newsletter will continue throughout their membership.

Other current memberships (1 and 3 year) will be phased out of receiving the hard copy based on their current membership agreement.

Any current member to include Life Members that wish to convert to electronic delivery only of the News may do so using the Conversion section under Membership on the webpage. Conversion to electronic only can in some cases extend your current membership by several months.

Our web pages are currently being edited to reflect these changes.

Questions regarding this action should be emailed to dave@nf0j.com

First Name* Last Name* Call Sign*

Mailing Address* Postal/Zip Code*

City* State or Country* Birth Year Email Address*

Contact List -- 10 Contacts with 1010 Members

For the Operator's Name in the form Below, please enter the one they used on the air during the contact. Do not use the one found in online services. Please Note: As of November 8 2013 KC4TVZ is no longer a member of Ten-Ten, Please do not submit his information on this application or any awards. When entering the station location, enter the 2 character US State abbreviation, or DX for all contacts outside of the US.

QSO Date* 10-10* Callsign* Name* US State or DX*

Can Correspondence with 10-10 International Net, Inc be done via your email address? Yes No

I certify that I meet the membership requirements of 10-10 (typing your name on this form is the equivalent to your personal signature):

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